- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.66 / $455.66 / $4,338.00
| Facility | | $455.66 | $455.66 | $4,338.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,421.65 / $2,421.65 / $2,421.65
| Facility | 50 | $2,421.65 | $2,421.65 | $2,421.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $434.89 / $628.39 / $1,101.20
| Facility | | $434.89 | $628.39 | $1,101.20 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,313.79 / $7,313.79 / $7,313.79
| Facility | 50 | $7,313.79 | $7,313.79 | $7,313.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.36 / $1,160.52 / $5,700.72
| Facility | | $814.36 | $1,160.52 | $5,700.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.02 / $755.21 / $861.02
| Professional | | $557.02 | $755.21 | $861.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,143.00 / $3,143.00 / $3,143.00
| Facility | | $3,143.00 | $3,143.00 | $3,143.00 |